富血小板血浆复合MTA盖髓的组织学观察

目的:从组织学方面探讨富血小板血浆(PRP)作为自身复合生长因子用于盖髓修复治疗的可行性。方法:选取2条健康成年杂种犬50颗牙齿,对每颗实验牙进行人工穿髓,制造牙髓损伤模型,单独应用PRP或将PRP与Dycal或MTA复合进行盖髓治疗,并设Dycal盖髓组和MTA盖髓组作为对照组进行比较,观察12周后各实验组修复性牙本质桥形成情况。结果:术后12周,MTA盖髓组中6例有完整的修复性牙本质桥形成;PRP组所有标本均未见有完整的修复性牙本质桥形成;PRP复合MTA盖髓组10例标本均可形成完整修复性牙本质桥;Dycal组有3例完整修复性牙本质桥形成;Dycal与PRP组1例有完整的修复性牙本质桥。结论:PRP与MTA复合盖髓具有良好的牙髓修复效果。     

富血小板血浆用于犬牙直接盖髓的实验研究

目的:观察富血小板血浆(platelet-rich plasma,PRP)直接盖髓后修复性牙本质的形成。方法:成年雄性健康杂种犬2只,分别取静脉血制备PRP后,选取每只犬的所有切牙,尖牙和前磨牙共48个牙作为对象,于颈部制作穿髓模型后,按拆分口设计原则随机分为6组(MTA、Dycal、MTA+PRP、Dycal+PRP、PRP、空白),分别用相应盖髓剂进行直接盖髓治疗,3个月后应用牙科CT观察各组穿髓处硬组织和牙本质桥形成情况。结果:实验3个月后,MTA,MTA+PRP,Dycal+PRP组修复性牙本质形成的效果均优于单纯氢氧化钙组(Dycal)。PRP组、空白组无完整的牙本质桥形成。结论:PRP+Dycal能促进犬富血小板血浆牙髓组织修复,是一种很有希望的复合型生物盖髓剂。     

Histological, ultrastructural and quantitative investigations on the response of healthy human pulps to experimental capping with mineral trioxide aggregate: a randomized controlled trial

AIM: To investigate the pulpal response to direct pulp capping in healthy human teeth with mineral trioxide aggregate (MTA) as against calcium hydroxide cement (Dycal) as control. METHODOLOGY: Twenty healthy human third molars had iatrogenic pulpotomy and direct pulp capping with MTA. Another 13 teeth were capped with Dycal as controls. The teeth were restored, with IRM, clinically reviewed and extracted after a number of pre-determined intervals (1 week, 1 month and 3 months). The specimens were fixed, decalcified, subdivided axially into two halves in the oro-buccal (lingual-buccal) plane, embedded in plastic, serial sectioned and evaluated qualitatively and quantitatively by correlative light and transmission electron microscopy with appropriate statistical evaluation of the quantitative data. RESULTS: Iatrogenic pulpal wounds treated with MTA were mostly free from inflammation after 1 week and became covered with a compact, hard tissue barrier of steadily increasing length and thickness within 3 months following capping. Control teeth treated with Dycal revealed distinctly less consistent formation of a hard tissue barrier that had numerous tunnel defects. The presence of pulpal inflammation up to the longest observation period (3 months) after capping, was a common feature in Dycal specimens. CONCLUSIONS: The MTA was clinically easier to use as a direct pulp-capping agent and resulted in less pulpal inflammation and more predictable hard tissue barrier formation than Dycal. Therefore, MTA or equivalent products should be the material of choice for direct pulp capping procedures instead of hard setting calcium hydroxide cements.     

MTA and calcium hydroxide for pulp capping

This study evaluated the biocompatibility of mineral trioxide aggregate (MTA) after direct capping of exposed pulp tissue in dog's teeth. Class I cavities were prepared in 26 teeth from 3 adult dogs. MTA was applied over the exposed pulp in 13 teeth and paste of calcium hydroxide plus distilled water (control) was applied in the remaining 13 teeth. After 90 days, the animals were killed; the maxilla and mandible were dissected and sectioned to obtain individual roots. The samples were processed histologically. The pulp and periapical response observed with the use of MTA was similar to that of calcium hydroxide paste. In all specimens, there was a dentin bridge obliterating the exposure, an intact odontoblastic layer, no inflammatory cells, normal connective pulp tissue, normal apical and periapical regions and no bone tissue changes. Similar to calcium hydroxide, MTA presented excellent response when used for direct pulp capping.     

Histomorphological response of dogs' dental pulp capped with white mineral trioxide aggregate

This study was conducted to observe the response of dogs' dental pulp to white mineral trioxide aggregate (MTA) when used as pulp capping material. The pulp of 15 dogs' teeth was experimentally exposed and capped with white MTA. The animals were sacrificed two months later and the specimens were prepared for histomorphological study. The pulp capped with white MTA showed a healing process with complete dentin bridge formation in all samples. In some cases, there was not a tubular dentin shape, but only a structure with an interesting morphological aspect sealing the exposure site. Only 2 specimens exhibited pulp inflammation. In conclusion, the data obtained in this study showed that white MTA has the necessary properties of a pulp capping material.     

Clinical, radiographic and histological analysis of the effects of mineral trioxide aggregate used in direct pulp capping and pulpotomies of primary teeth

Background : Primary teeth pulp exposures have traditionally been treated with formocresol or ferric sulphate pulpotomies or calcium hydroxide pulp capping. The aim of this study was to observe the tissue response when mineral trioxide aggregate (MTA) was used.
Methods : Ten primary teeth had direct pulp caps and 11 had a pulpotomy with MTA. The teeth were restored and then clinically reviewed monthly for five months and before extraction. Radiographs were taken prior to treatment, after one month and prior to extraction. After extraction, the teeth were examined histologically and the responses to treatment were assessed.
Results : One pulpotomy and two pulp capping cases had postoperative pain and signs of pulp degeneration. Radiographs showed no root resorption, no periodontal pockets and no furcation radiolucencies. No cases had draining sinuses or increased mobility. Most pulps responded favourably from a clinical perspective although a variety of responses were noted Histologicallyormal odontoblasts, irregular odontoblasts, intrapulpal calcifications, dentinal bridges, cementum formation, internal resorption, inflammatory infiltrate and pulp necrosis.
Conclusions : The responses of pulps in primary teeth to MTA pulpotomies and pulp caps were favourable from clinical and radiographic perspectives although a variety of histological responses were noted. MTA may be a favourable material for pulp capping and pulpotomies in primary teeth.     

A comparative study of white and grey mineral trioxide aggregate as pulp capping agents in dog's teeth

Abstract –  Mineral trioxide aggregate (MTA) is widely used for different perforation repairs, root-end filling, pulp capping and many other endodontic procedures. Because of potential discoloration effect of gray MTA, white MTA has been introduced into endodontic treatment for the same purposes. This study examined the dental pulp responses in dogs to both types of MTA used as a pulp-capping agent. The pulps of 24 teeth of four male dogs were exposed with a No.1 round bur and capped with either gray or white MTA. Histologic analysis was performed one and 2 weeks after treatment. Calcified bridge could be seen 1 week after treatment with both types of MTA, with no significant differences between the two treatments.     

Response of the pulp of dogs to capping with mineral trioxide aggregate or a calcium hydroxide cement

Abstract – This study was conducted to observe the response of dogs' dental pulp to mineral trioxide aggregate (MTA) and a calcium hydroxide cement when used as pulp capping materials. After the pulps of 30 teeth were exposed, they were capped with either MTA or a calcium hydroxide cement. Histological analysis was performed 2 months after treatment. Results showed a healing process with complete tubular dentin bridge formation and no inflammation in any of the pulps capped with MTA. On the other hand, only five specimens from the calcium hydroxide cement group formed a complete dentin bridge. In this experimental group, pulp inflammation was observed in all but three cases. In conclusion, MTA exhibited better results than the calcium hydroxide cement for the capping of the pulp in dogs.     

Dycal��MTAֱ�Ӹ�����������BMP-2�ı��仯

目的观察Dycal和矿物三氧化物凝聚体（MTA）在大鼠磨牙直接盖髓后骨形态发生蛋白（BMP）-2的表达变化。方法本研究于2011年3月至2012年12月在中国医科大学口腔医学院中心实验室及辽宁省口腔医学研究所进行。42只雌性Wistar大鼠双侧上下第一磨牙分别用Dycal和MTA直接盖髓，在各观察时点（盖髓后12h及1、3、7、14、21、28d）处死动物取材，进行BMP-2免疫组织化学染色，用图像分析软件测定各组标本中BMP-2阳性染色的平均光密度值。用SPSS13．0统计软件对数据分别进行配对t检验和Dunnett-t检验。结果在正常牙髓组织中BMP-2表达呈阴性，Dycal和MTA直接盖髓后12h牙髓中BMP-2出现低水平表达并逐渐增强，7d时达到高峰，14d后表达开始下降，至28d时接近正常水平。MTA组修复性牙本质形成较Dycal组连续且致密，7、14d时MTA组BMP-2表达强度高于Dycal组。结论MTA组形成修复性牙本质较Dycal组连续且致密，BMP-2的表达高于Dycal组；MTA可能通过调节BMP-2的表达参与诱导修复性牙本质的形成，BMP-2的表达强度可能影响了牙髓损伤修复。     

光敏黏接剂盖髓后牙髓的组织病理反应

目的观察应用3种光敏黏接剂直接盖髓后,兔牙髓的反应。方法兔前臼齿及臼齿72颗,分为4组,制备Ⅰ类洞机械穿髓,实验组3组(Excite,Prime & Bond NT,XenoⅢ),Dycal为对照,光敏树脂(SureFil)充填。于第7、14、21天每组拔除6颗牙齿,常规脱钙切片,镜下观察充血反应、炎细胞浸润、纤维化程度、牙本质桥形成、修复性牙本质形成、细菌污染等情况。结果所有实验牙齿都有牙本质桥形成,修复性牙本质封闭穿髓孔。同一时期内,兔牙髓对不同盖髓剂的反应无显著性差异。除对照组外,同种黏接剂在不同时期内对牙髓的影响无显著性差异。结论此3种黏接剂对兔牙髓具有良好的生物相容性,并能促进修复性牙本质生成。     

Evaluation of two mineral trioxide aggregate compounds as pulp-capping agents in human teeth

Aim  The present randomized, controlled prospective study evaluated the histomorphological response of human dental pulps capped with two grey mineral trioxide aggregate (MTA) compounds.
Methodology  Pulp exposures were performed on the occlusal floor of 40 human permanent pre-molars. The pulp was capped either with ProRoot (Dentsply) or MTA-Angelus (Angelus) and restored with zinc oxide eugenol cement. After 30 and 60 days, teeth were extracted and processed for histological examination and the effects on the pulp were scored. The data were subjected to Kruskal–Wallis and Conover tests (α = 0.05).
Results  In five out of the 40 teeth bacteria were present in pulp tissue. No significant difference was observed between the two materials ( P  > 0.05) in terms of overall histological features (hard tissue bridge, inflammatory response, giant cells and particles of capping materials). Overall, 94% and 88% of the specimens capped with MTA-Angelus and ProRoot, respectively, showed either total or partial hard tissue bridge formation ( P  > 0.05).
Conclusions  Both commercial materials ProRoot (Dentsply) and MTA-Angelus (Angelus) produced similar responses in the pulp when used for pulp capping in intact, caries-free teeth.     

Maturogenesis of a cariously exposed immature permanent tooth using MTA for direct pulp capping: a case report

Abstract –  Successful direct pulp capping of cariously exposed permanent teeth with reversible pulpitis and incomplete apex formation can prevent the need for root canal treatment. A case report is presented which demonstrates the use of mineral trioxide aggregate (MTA) as a direct pulp capping material for the purpose of continued maturogenesis of the root. Clinical and radiographic follow-up demonstrated a vital pulp and physiologic root development in comparison with the contralateral tooth. MTA can be considered as an effective material for vital pulp therapy, with the goal of maturogenesis.     

Effect of mineral trioxide aggregate on dentin bridge formation and expression of dentin sialoprotein and heme oxygenase-1 in human dental pulp

This study was conducted to evaluate the pulpal response to direct capping with either mineral trioxide aggregate (MTA) or calcium hydroxide (CH) cement in humans, with a focus on dentin bridge formation and dentin sialoprotein (DSP) and heme oxygenase-1 (HO-1) expression. Direct pulp capping was performed in 20 cases of caries-free human third molars. The pulps were exposed and capped with either MTA or hard-setting CH. After 2 months, the teeth were extracted, and the specimens were prepared for histologic and immunohistochemical evaluations. Histologically, 100% of the MTA group and 60% of the CH group developed dentin bridges. The mean thickness of the dentin bridges observed in the MTA group was statistically greater than that of CH group. In addition, DSP and HO-1 were expressed in the odontoblast-like cells and pulp fibroblasts beneath the dentin bridge; furthermore, significantly greater immunostaining was observed in the MTA group than in the CH group. Collectively, these results indicate that MTA is superior to CH in terms of inducing the dentinogenic process in human pulp capping.     

Clinical long-term evaluation of MTA as a direct pulp capping material in primary teeth

Aim To evaluate the effectiveness of mineral trioxide aggregate (MTA) when used as a pulp capping material in primary teeth. Methodology Clinical follow‐up was performed on 25 symmetrical pairs of primary molars with deep occlusal caries, in 25 patients between the ages of 5 and 8 years. Pulps exposed during cavity preparation were treated by direct pulp capping with MTA or calcium hydroxide, based with resin‐bonded zinc oxide eugenol cement and restored with amalgam. Clinical and radiographic examinations were carried out at 1, 3, 6, 9, 12, 18 and 24 months. Results Twenty‐four‐month clinical and radiographic follow‐ups were carried out on 22 patients. One patient failed to return for evaluation after 1 month, one after 9 months and another after 12 months. During follow‐up, none of the MTA and calcium hydroxide groups exhibited clinical or radiographic failure. Conclusions Mineral trioxide aggregate was found to be as successful as calcium hydroxide when used for direct pulp capping in primary teeth. Further histological investigations are needed to support these findings.     

Microscopic analysis of dog dental pulp after pulpotomy and pulp protection with mineral trioxide aggregate and white Portland cement

Considering previous studies on the similarity between the chemical composition of the mineral trioxide aggregate and the Portland cement, the purpose of this study was to investigate the pulp response of dog's teeth after pulpotomy and direct pulp protection with MTA Angelus and white Portland cement. Thirty eight pulp remnants were protected with these materials. One hundred and twenty days after treatment, the animals were sacrificed and the specimens removed and prepared for histological analysis. Both materials demonstrated the same results when used as pulp capping materials, inducing hard tissue bridge formation and maintaining pulp vitality in all specimens. The MTA Angelus and the white Portland cement showed to be effective as pulp protection materials following pulpotomy.     

不同盖髓材料用于盖髓术的临床研究

目的 比较可乐丽菲露SE3 BOND和Dycal氢氧化钙盖髓的临床效果。方法 将79例患者的84颗患牙分成2组,乐丽菲露SE3 BOND 组62颗患牙,Dycal氢氧化钙组22颗患牙。2组病例分别用Dycal氢氧化钙以及可乐丽菲露SE3 BOND盖髓,光固化玻璃离子垫底,光固化复合树脂充填。结果 盖髓治疗8个月后追踪观察,深龋近髓的患牙用Dycal氢氧化钙盖髓的成功率93.5%,与用可乐丽菲露SE3 BOND盖髓（87.1%）比较,差异无统计学意义(P>0.05）;深龋穿髓的患牙用Dycal氢氧化钙盖髓的成功率（75%）明显高于可乐丽菲露SE3 BOND（50% ）,差异有统计学意义（P<0.05）。结论 在深龋近髓患牙盖髓术治疗中,可乐丽菲露SE3 BOND和Dycal氢氧化钙的疗效均佳,但在深龋穿髓患牙盖髓术治疗的病例中,Dycal氢氧化钙对深龋穿髓疗效明显优于可乐丽菲露SE3 BOND。     

iBond粘结剂、Single Bond粘结剂用于比格犬直接盖髓术的组织学评价

[摘要] 目的 对第七代牙本质粘接剂iBond和第五代牙本质粘接剂Single Bond及VLC Dycal的体内细胞毒性进行研究。方法 选择4只比格犬共72颗健康牙齿,在颊面制备Ⅴ类洞并在洞底做人工穿髓孔,然后分为3组,第1组和第2组分别用Single Bond和iBond,第3组用VLC Dycal盖髓作为阳性对照组。选取比格犬口内剩余健康牙齿24颗,不做处理作为阴性对照组。所有实验牙齿分别在盖髓后的第7、30天拔出,并进行组织学评价。结果 7 d时,3组材料均出现不同程度的炎症反应和组织紊乱,但其差异无统计学意义;30 d时,iBond和VLC Dycal两组的炎症反应较Single Bond组弱,其差异有统计学意义(P<0.05);3组材料均有不同程度的组织紊乱,其差异无统计学意义;所有样本未见有牙本质桥形成。结论 iBond对牙髓的刺激性较小;Single Bond对牙髓的刺激性较大。     

Clinical assessment of mineral trioxide aggregate (MTA) as direct pulp capping in young permanent teeth

Carious pulp exposure in permanent molars of children is a common incident. Mineral trioxide aggregate is a new material that possesses numerous exciting possibilities for pulp therapy. AIM: The purpose of this study was to evaluate the efficiency of MTA as a direct pulp capping agent in young permanent teeth. METHODS: Thirty asymptomatic permanent molars with pulp exposures were treated by pulp capping using MTA. At each recall (6 12, 18 and 24 months), the teeth were assessed clinically, through pulpal sensitivity tests, as well as radiographically to evaluate periapical healing. RESULTS: None of the cases reported spontaneous pain at the six months follow up and the pulp showed signs of vitality and absence of periapical radiolucency. At 24 months, the clinical and radiographic success rate was 93% with evidence of continued root growth. CONCLUSION: Pulp capping with MTA is recommended for teeth with carious pulp exposures specially immature teeth with high potential for healing.     

The effect of mineral trioxide aggregate on the mineralization ability of rat dental pulp cells: an in vitro study

The aim of this study was to investigate the effect of mineral trioxide aggregate (MTA) on cell viability and mineralization ability of rat dental pulp cells. The pulp capping materials, such as MTA, Dycal (Dentsply Caulk, Milford, DE), and Superbond C&B (SB; Sun Medical, Shiga, Japan) were placed on transwell inserts and cultured with rat dental pulp cells. MTA and SB exhibited no cytotoxicity, whereas almost all cells had died after 72 hours of culture with Dycal. MTA significantly stimulated mineralization by 60% compared with the control. MTA and Dycal significantly upregulated by two-fold the level of bone morphogenetic protein (BMP)-2 messenger RNA expression compared with the control. Furthermore, MTA increased BMP-2 protein production by about 40%, whereas Dycal significantly reduced it. Although MTA and Dycal increased the concentration of extracellular calcium by about 0.4 mmol/L, SB had no effect. These results suggest that BMP-2 may play an important role in mineralization stimulated by MTA.